During a time in which public health efforts have successfully decreased cigarette use in the U.S., alternative tobacco products are becoming popular with adolescents and young adults. There has been a tremendous increase in hookah use among these populations, with the proliferation of hookah cafes nationwide. The potential for acceptance of tobacco products, addiction, and multiple tobacco product use is a significant public health threat. This funding is intended to support new investigators whose interests focus on behavioral research aimed at helping people control behaviors that increase cancer risk, and tobacco use is one of the biggest contributors to cancer in the United States. Hookah research thus far has contributed to the knowledge of actual harm in use, prevalence rates among adolescents and young adults, and perceptions of lack of harm. No known studies have investigated reasons for use, and outcomes expectancy theory provides a framework for assessing positive associations as reasons for behaviors. Therefore, using the outcomes expectancy theory, we will conduct focus groups with young adult hookah users to ascertain their positive and negative outcome expectations. From an iterative data analysis methodology, we will develop themes from these focus groups and then an item pool of questions to assess hookah use. These questions will be discussed and further refined by an expert panel; experts in both hookah use and outcomes expectancy theory. Finally, we will pilot test a survey instrument to 400 hookah users at the University of Florida. We will use the pilot data to also conduct a confirmatory factor analysis to validate the instrument. The study will be conducted with the following two aims: Specific Aim 1: Develop an item pool that encompasses the breadth of hookah use, using expectancy theory (content and face validity). Hookah smokers' positive and negative outcomes expectancies will be assessed through focus groups. The developed themes will be presented to an expert panel for better validation and refinement of the item pool and subsequent survey measure. Specific Aim 2: Distribute new instrument and test Item Response Theory (IRT) model assumptions and psychometric properties (construct validity). The measure will be validated by collecting pilot data to assess endorsement of items. Further, factor analysis methodologies will be used to confirm the factor structure of the new instrument. PUBLIC HEALTH RELEVANCE: Since one-half to two-thirds of cancer deaths can be linked to behavioral factors (PAR-09-003) we must understand why an individual chooses to partake in a behavior. Using outcomes expectancy theory, this project will provide a framework to better understand why a young adult population would initiate a new tobacco product, in a time in which public health efforts have successfully reduced cigarette smoking.